Mississippi Sports Medicine and Orthopaedic Center

HIV is a retrovirus affecting the body's immune system. People living with HIV (PWH) aged ≥45 have a higher risk of atherosclerotic cardiovascular disease (ASCVD). Statins are generally recommended for PWH with a 10-year ASCVD risk of ≥5%. This project aimed to promote evidence-based practices (EBPs) regarding statin-prescribing for eligible PWH in an outpatient specialty clinic. Guided by the JBI Evidence Implementation Framework, two EBPs for increasing statin-prescribing were used as audit criteria: (1) use of a validated tool to estimate ASCVD risk and (2) presence of an alert for clinicians in the electronic health record (EHR) for positive screenings. To determine compliance with EBPs, a baseline audit was completed via EHR reviews. Then, barriers to compliance were identified and strategies to improve compliance were implemented. A follow-up audit was conducted to measure changes in compliance with best practices. The baseline audit revealed 56% and 0% compliance with the two EBPs, respectively. Barriers to compliance included the absence of a standardized process for estimating patients' CVD risk and clinicians often being unaware of patients' statin eligibility. Strategies to improve EBP compliance included using a "Smart Phrase" to automatically insert a calculation of the 10-year ASCVD risk score into the EHR and placing a statin eligibility notification into eligible patients' EHRs. The follow-up audit indicated a decrease in compliance for Criterion 1 (56% to 52%) but an increase of 100% for Criterion 2. The project objective was partially met, but interventions were impractical for sustainability. Prescribing practices among nurse practitioners and medical doctors should be explored, as differences in prescribing habits were noticeable. http://links.lww.com/IJEBH/A516.

Introduction: Intercellular adhesion molecule (ICAM)-1 has been implicated in the pathogenesis of heart failure with preserved ejection fraction (HFpEF). The ICAM1 p.K56M variant (rs5491) alters ICAM-1 binding function and is present in ~35% of Black individuals, but is rare in other race/ethnicity groups. Although ICAM1 p.K56M (rs5491) is associated with increased risk of HFpEF, granular pathways connecting rs5491 to HFpEF remain unclear. The presence of adiposity, and specifically pericardial fat, has also been strongly associated with increased risk of HFpEF. Hypothesis: As ICAM1 p.K56M and adiposity are both separately associated with HFpEF, we hypothesized that the rs5491 variant is associated with measures of adiposity. Methods: Among the Black individuals in the Multi-Ethnic Study of Atherosclerosis (MESA) we assessed associations between rs5491 and baseline adiposity measures (body mass index [BMI], waist circumference, pericardial fat volume, and hepatic fat). Pericardial fat volume and hepatic attenuation were quantified by computed tomography (CT) at baseline examination. As higher hepatic fat is indicated by lower hepatic attenuation, the inverse of hepatic attenuation was used for models evaluating hepatic fat. Results: Among 1,590 individuals (mean age 62±10 years, 54% female, mean BMI 30±6 kg/m2), 594 (37%) had one or more copy of rs5491, median pericardial fat volume was 61.2 (IQR: 42.3-86.5) cm3 and median hepatic attenuation was 64.1 (IQR: 57.8-69.9) Hounsfield units (HU). There were weak to modest but statistically significant correlations between pericardial fat and other adiposity measures (Figure 1A). Each additional rs5491 allele was significantly associated with higher pericardial fat volume after covariate adjustment, which included adjustment for BMI (Figure 1B). There were no significant associations of rs5491 with hepatic fat, BMI, or waist circumference. Conclusions: In an older cohort of Black individuals, the ICAM1 p.K56M HFpEF risk variant (rs5491) was significantly associated with higher pericardial fat volume, but not with other measures of adiposity. These findings suggest that pericardial adiposity may be a pathway by which rs5491 promotes HFpEF risk.

Experience with the RevCore mechanical thrombectomy device in a series of 40 patients is described. The device was employed in the treatment of symptomatic in-stent restenosis (ISR) in iliofemoral caval venous stents in these patients. Computed tomography venography was performed preoperatively to differentiate ISR from stent compression in all patients who underwent intervention. All patients were treated in a single session with a mean estimated blood loss of <10 mL with an average operative time of <30 minutes. Alteplase was not used in any patient. All patients were discharged home the same day. Resolution of ≥50% ISR at the end of the procedure on intravascular ultrasound examination was noted in all patients. Symptom resolution was noted in all patients after the use of the RevCore device. No clinical perioperative pulmonary embolism was observed. Only one patient (2.5%) required reintervention during the follow-up period (range, 2-24 months).

Aim: The availability of long-term (>2years) safety outcomes of spinal cord stimulation (SCS) remains limited. We evaluated safety in a global SCS registry for chronic pain. Methods: Participants were prospectively enrolled globally at 79 implanting centers and followed out to 3yearsafter device implantation. Results: Of 1881 participants enrolled, 1289 received a permanent SCS implant(1776completed trial). The annualized rate of device explant was 3.5% (all causes), and 1.1% due to inadequate pain relief. Total incidence of device explantation >3years was 7.6% (n=98). Of these, 32subjects (2.5%) indicated inadequate pain relief as cause for removal. Implantsite infection (11 events) was the most common device-related serious adverse event(<1%). Conclusion: This prospective, global, real-world study demonstrates a high-level of safety for SCS with low rate of explant/serious adverse events. Clinical Trial Registration: NCT01719055 (ClinicalTrials.gov).

Background:The addition of genetic analysis to the evaluation of thyroid nodule fine-needle aspiration biopsy samples improves diagnostic accuracy of cytologically indeterminate thyroid nodules (ITNs) with Bethesda III or IV cytopathology. We previously reported the performance of a multiplatform molecular test, referred to in this study as MPTXv1, that includes a mutation panel (ThyGeNEXT®) plus an algorithmic microRNA (miRNA) risk classifier (ThyraMIR®). Complex interactions of growth-promoting and -suppressing miRNAs affect the phenotype. We previously demonstrated that accounting for these interactions with pairwise miRNA expression analysis improves the diagnosis of medullary thyroid carcinoma. In this study, we assess the impact of pairwise miRNA expression analysis on risk stratification of ITNs.Methods:Pairwise expression analysis of 11 miRNAs was performed on a training cohort of histopathology-proven benign nodules (n = 50) to define the mean and standard deviation of each pairwise analysis and create a Benign/Malignant Profiler (MPTXv2), deviations from which predicted the malignancy risk. Clinical validation of MPTXv2 was assessed using a cohort of 178 ITN (Bethesda III and IV) samples from a multicentered, blinded retrospective study, previously evaluated by MPTXv1.Results:Compared with MPTXv1, MPTXv2 significantly improved the test performance. The receiver operating characteristic (ROC) areas under the curve (AUC) increased from 0.85 to 0.97 (p < 0.001), and the diagnostic accuracy at the positive threshold increased significantly (p < 0.05) from 83% [95% confidence interval (CI) = 76–88] to 93% [CI = 89–96]. The significant improvement in the ROC AUC and the diagnostic accuracy was due to a strong statistical trend for improvement in specificity at the positive threshold. At the positive threshold, the specificity for MPTXv1 was 90% [CI = 84–95] and improved to 98% [CI = 94–99] for MPTXv2. Using the MPTXv2, the Moderate-Risk cohort decreased from 50 samples (28% of the cohort) to 24 samples (13% of the cohort). This 52% decrease is statistically significant (p < 0.001) and clinically meaningful.Conclusion:As compared with MPTXv1, pairwise miRNA expression analysis used in MPTXv2 significantly improved the diagnostic accuracy of ITN risk stratification and reduced the size of the Moderate-Risk group. Prospective trials are indicated to confirm these findings in a clinical practice setting.